Effectiveness of Sirolimus in Combination with Cyclosporine against Chronic Rejection in a Pediatric Liver Transplant Patient
-
- Shinke Haruka
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Hashi Sachiyo
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Kinoshita Risa
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Taniguchi Risa
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Sugimoto Mitsuhiro
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Matsubara Kazuo
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
-
- Ogawa Eri
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Sonoda Mari
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Takada Narito
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Yoshizawa Atsushi
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Ogawa Kohei
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Okamoto Shinya
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Uemoto Shinji
- Divisions of Hepato-Pancreato-Biliary, Transplant and Pediatric Surgery, Department of Surgery, Kyoto University Hospital
-
- Masuda Satohiro
- Department of Pharmacy, Faculty of Medicine, Kyoto University Hospital
Search this article
Abstract
The patient is a 3-year-old boy who received living-donor liver transplantation (LDLT) for hepatoblastoma, with his mother as the donor. Oral tacrolimus was started at a dose of 0.3 mg every 12 h from day 1, with the dosage adjusted on the basis of trough concentrations. The levels of aspartate aminotransferase (AST), alanine transferase (ALT), and total bilirubin (T-bil) were 110 U/L, 182 U/L, and 12.6 mg/dL, respectively, when chronic rejection (CR) was pathologically diagnosed. Then, sirolimus at a dose of 1.0 mg/d was added to the tacrolimus-based regimen. The T-bil level rapidly decreased to 5.4 mg/dL, without changes in AST and ALT. Because the intracellular receptor of sirolimus and tacrolimus is FK506-binding protein 12, we switched tacrolimus to cyclosporine at a dose of 60 mg/d to avoid competitive inhibition between these 2 drugs. The target trough concentration of sirolimus and cyclosporine was set to around 15 ng/mL and 180 ng/mL, respectively. The concentration/dose ratio of sirolimus was significantly correlated with the blood cyclosporine level (r=0.5293, p<0.05), suggesting the pharmacokinetic interaction between these 2 drugs. Thereafter, the levels of AST and ALT as well as the T-bil were successfully decreased to 73 U/L, 83 U/L, and 3.0 mg/dL, respectively. These results suggest that sirolimus therapy in combination with cyclosporine may be an effective treatment against CR after liver transplantation.
Journal
-
- Biological and Pharmaceutical Bulletin
-
Biological and Pharmaceutical Bulletin 36 (7), 1221-1225, 2013
The Pharmaceutical Society of Japan
- Tweet
Keywords
Details 詳細情報について
-
- CRID
- 1390282679609243520
-
- NII Article ID
- 130003361486
-
- NII Book ID
- AA10885497
-
- COI
- 1:STN:280:DC%2BC3snktVWqsQ%3D%3D
-
- ISSN
- 13475215
- 09186158
-
- HANDLE
- 2433/178726
-
- NDL BIB ID
- 024644845
-
- PubMed
- 23676788
-
- Text Lang
- en
-
- Data Source
-
- JaLC
- IRDB
- NDL
- Crossref
- PubMed
- CiNii Articles
-
- Abstract License Flag
- Disallowed